Vol 8, No 6 (2004)
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Published online: 2004-12-14

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Effects of angiotensin converting enzyme inhibitor on end-organ changes in relation to aortic compliance in young patients with essential hypertension

Beata Krasińska, Andrzej Tykarski, Olga Trojnarska
Nadciśnienie tętnicze 2004;8(6):393-401.


Background The role played by impaired arterial compliance in the patogenesis of isolated systolic hypertension in elderly patients is well recognized. However little it is known about the role that elastic properties of arteries can play in young hypertensives. ACE-inhibitors most effectively improve aortic compliance. There are no clear indications to start antihypertensive therapy with particular group of drugs. One can make hypothesis that arterial compliance can influence the choice of antihypertensive drug in young hypertensives.
The aim of the study was to evaluate the effect of ACE inhibitor on blood pressure, aortic compliance, left ventricular mass index and renal hemodynamic parameters in young hypertensives depending on the arterial compliance.
Material and methods Forty five patients were screened and 28 patients aged 19–40 years (average age 33.5 ± 3.7) met the criteria of mild to moderate hypertension. All patients were treated with perindopryl in dose 4 mg for 6 months.
The following procedures were performed twice, before and after the 6-month period of treatment in these patients: clinical blood pressure with sphygmomanometer and 24-hour automatic blood pressure monitoring, the estimation of aortic PWV, left ventricular mass index (LVMI) and renal hemodynamic parameters. The patients were divided into subgroups according to PWV: HC+ (PWV < 9.2 m/s) i HC– (PWV > 9.2 m/s).
Results ACE-inhibitor treatment caused significant reduction of systolic and diastolic blood pressure in clinical and 24-h automatic measurement both in HC+ and HC- group. Fall in pulse pressure was significantly (p < 0.01) higher in HC- group in comparison with HC+ group (-12.4 ± 6.9 mm Hg vs. -5.5 ± 5.4 mm Hg respectively). PWV decreased significantly in HC+ and HC-patients, from 8.67 ± 0.3 m/s to 7.96 ± 0.5 m/s and from 12.6 ± 2.0 m/s to 10.4 ± 1.6 m/s respectively. However LVMI decreased only in HC- patients from 120.1 ± 6.7 g/m2 to 109.4 ± 7.3 g/m2 PWV decreased more (p < 0.001) in HC- patients (ΔPWV -2.2 ± 1.1 m/s) in comparison with HC+ patients (ΔPWV –0.7 ± 0.5 m/s). Also LVMI decreased significantly more (p < 0.001) in HC- patients (ΔLVMI -10.7 ± 3.7 g/m2) than in HC+ patients (ΔLVMI -0.2 ± 0.6 g/m2).
Renal blood flow increased and renal vascular resistance decreased similarly in both groups.
Conclusions 1. ACE inhibitors more efficiently decrease pulse pressure in young patients with hypertension and reduced arterial compliance than in other subjects. 2. The decrease of PWV and regression of LVMI is more substantial in hypertensive patients with reduced arterial compliance. 3. ACE inhibitors increase renal blood flow independently from arterial compliance in young hypertensives. 4. It seems that arterial compliance can influence the choice of antihypertensive drug in young hypertensives. The occurrence of the reduced arterial compliance suggests the choice of the ACE inhibitor.

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